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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1056985

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1. JILL STEIN FOR PRESIDENT

    22 KENDALL ROAD
    LEXINGTON, MA 02421
    Email: Treasurer@Jill2016.com;Finance@Jill2016.com

    NOTE: Email address is different than previously reported

2. Date: 03/18/2016

3. FEC Committee ID #: C00581199 This committee is a Principal Campaign Committee. Candidate: JILL STEIN
Party: Green Party
Office Sought: President
State is in District: 00

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Matthew Kozlowski
1622 Fordem Ave
#401
Madison, WI 53704
Title: Dir. of Compliance
Phone # (715) 571-1577

Treasurer:

Steven Welzer
58 Brooktree Rd
East Windsor, New Jersey 08520
Title: Treasurer
Phone # (609) 443-6782

Designated Agent(s):

Banks or Depositories

Summit Credit Union
PO Box 8046
Madison, Wisconsin 53708

Signed: Steven Welzer
Date Signed: 03/21/2016
Official Committee URL: www.Jill2016.com

(End FEC FORM 1)

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